Active NPI
Jeremey Shultz, CRM
- Peer Specialist
- Albany, OR
National Provider Identifier
1790475234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 231 Lyon St SE
Albany, OR 97321-2707 - Phone
- (541) 791-3411
- NPI assigned
- May 9, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | OR | ||
| Peer Specialist | 175T00000X | OR | Primary |
Addresses
Primary practice location
231 Lyon St SE
Albany, OR 97321-2707
Mailing address
1350 SW Ellis St
Dallas, OR 97338-2438
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | chancerecovery.net | Health Information Exchange (HIE) | |
| Other URL | chancerecovery.net |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683590400000",
"number": "1790475234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 SW ELLIS ST",
"city": "DALLAS",
"state": "OR",
"postal_code": "973382438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 LYON ST SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973212707",
"telephone_number": "541-791-3411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULTZ",
"first_name": "JEREMEY",
"credential": "CRM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-09",
"last_updated": "2023-05-09",
"certification_date": "2023-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "chancerecovery.net",
"affiliation": "N",
"endpointDescription": "direct url",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "NA",
"address_1": "231 Lyon St SE",
"city": "Albany",
"state": "OR",
"country_code": "US",
"postal_code": "973212707",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "chancerecovery.net",
"affiliation": "N",
"address_1": "231 Lyon St SE",
"city": "Albany",
"state": "OR",
"country_code": "US",
"postal_code": "973212707",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Albany, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.